“We believe there is a lack of clear regulatory direction regarding the responsibilities of providers in caring for LTC facility residents who receive hospice care from a Medicare-certified hospice provider, which could result in duplicative or missing services,” the CMS rule stated. “We believe this problem would be remedied by a regulatory requirement for a written agreement between the two types of entities when they are both involved in the care of a Medicare beneficiary.

“A written agreement would help ensure that required services are provided to beneficiaries and protect beneficiary health and safety, which could be endangered by a lack of coordination between hospice and LTC providers.”

Under the rule, when care is provided by a Medicare-certified hospice in an LTC facility, the LTC facility would be required to meet additional requirements specific to written agreements between the two entities. The LTC facility would then need to ensure that the hospice services meet professional standards and are timely. Authorized representatives from both the hospice and LTC facility would need to sign the agreement.